faculty of nursing herdís sveinsdóttir1 women’s decision making and attitudes towards hormone...

Herdís Sveinsdóttir 1

Faculty of Nursing

Women’s Decision Making and Attitudes Towards Hormone Therapy in the

Aftermath of the WHI Study

Herdís Sveinsdóttir, RN, PhDAssociate Professor, Faculty of Nursing

University of IcelandRagnar Ólafsson, PhD cand,

Institute of Nursing Research, University of Iceland


Faculty of Nursing

Bakground of studyBakground of study

Shift in the discourse on menopause in the medical literature from discourse on treatment towards discourse on prevention


Faculty of Nursing

Bakground of studyBakground of study

Discontinuation of the WHI- study in 2002


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Study SettingStudy Setting

Icelandic Health Care System Access to Health Care


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Prevalence of Hormone Therapy (HT) in Prevalence of Hormone Therapy (HT) in IcelandIceland

1986 – 1995 5.7 fold increase in use of HT 1996 – 2001 57% of 52-57 year old women used

HT

Long-time use has increased steadily: 1990 – 1995 27% of users had used HT> 5 years1996 – 1998 49% of users had used HT> 5 years1999 – 2001 67% of users had used HT> 5 years


Faculty of Nursing

Markmið 1Markmið 1

Lýsa hvað hefur áhrif á ákvörðun kvenna um að nota tíðahvarfahormóna, líðan þeirra við tíðahvörf, heilsu og lífsstíl, viðhorfum til tíðahvarfa og til notkunar tíðahvarfahormóna, mati þeirra á fræðslu sem þær hafa fengið um tíðahvörf og afstöðu þeirra til ýmissa atriða sem tengjast þekkingu á fyrrnefndri rannsókn.


Faculty of Nursing

Objective 2Objective 2

This study sought to illuminate how women make decisions about HT by describing the attitudes towards HT (ATHT) and determining the effect of demographic characteristics, attitudes towards menopause, menopausal education, symptom experience, health and lifestyle and knowledge about the findings of the Women’s Health Initiative study on attitudes towards HT.


Faculty of Nursing

MethodMethod

Design: Cross-sectional descriptive survey Population: Women aged 47 – 53, residing in

Reykjavík and neighbouring towns Sample: 1000 women, meeting the criteria,

randomly selected from the national registry of Iceland

Data collection method: Posted questionnaire Response rate: 56.1%


Faculty of Nursing

InstrumentInstrumentSelf-administered questionnaire that assessed: socio-demographics (age, education, marital status) attitudes towards menopause (Hvas et al., 2003) ATHT (Hvas et al., 2003) menopausal status, incl. surgical operations use of HT menopausal education (source, perceived adequacy) awareness of the findings from the WHI study presented

in 2002 symptom experience use of alternative remedies


Faculty of Nursing

ÚrvinnslaÚrvinnsla Við lýsandi úrvinnslu gagna voru niðurstöður skoðaðar

út frá eftirtöldum breytum: aldri, því hvort viðkomandi væri komin á tíðahvörf, væri ekki komin á tíðahvörf eða vissi ekki af því og út frá notkun tíðahvarfahormóna. Notkun tíðahvarfahormóna var skipt upp í aldrei notað, notað en er hætt og nota núna. Frekari greininga gagna byggði á lýsandi tölfræði og var marktækni mæld með kí-kvaðrat prófi, Fisher exact prófi og dreifigreiningu


Faculty of Nursing

AnalysisAnalysis

Regression models were used to explain ATHT. ATHT were compared on the study variables

using ANOVAs, t-tests or correlations. Variables showing significant differences or

significant relationships with the ATHT scale were entered into a multiple regression model.


Faculty of Nursing

Menopause is a normal part of women’s life Menopause is a good experience for women Menopause is a period of personal growth Menopause is a period one has to tackle Menopause is a boring time for women Menopause is a bad experience for women

Hvas L., Thorsen H. & Söndergaard, K. (2003) Discussing menopause in general practice. Maturitas 46, 139-146.

Attitudes towards menopauseAttitudes towards menopause

Responses: Agree, disagree, Neutral

Chronbacs alpha 0.72

Mean score on the attitudes towards menopause scale was 1.9 (SD=0.53) – higher score indicative of more positive attitude


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HT is a good solution if one has many symptoms HT is a good solution, even if one experiences only few symptoms HT is to be avoided HT is unhealthy HT is a good solution to prevent age-related health problems HT is a bad solution to prevent age-related health problems HT has many side-effects

Hvas et al., 2003

ATHT-ScaleATHT-Scale

Responses: Agree, disagree, Neutral

Chronbacs alpha 0.82

Mean score on the attitudes towards menopause scale was 2.2 (SD=0.60)

– higher score indicative of more positive attitude


Faculty of Nursing

)

Are you menopausal (N=561)?

0

10

20

30

40

50

60

1

Menopausal status

%

Yes

No

I don´t know


Faculty of Nursing

Tafla 1.

Hlutfall kvenna sem notað hefur tíðahvarfahormón út frá fæðingarári og hvort þær

segjast vera komnar á tíðahvörf

Notað tíðahvarfahormón

Já

Ert þú komin á tíðahvörf (N=535)*

Já 66%

Nei 16%

Veit ekki 30%

Fæðingarár (N=552)**

1951 70%

1952 59%

1953 50%

1954 45%

1955 39%

1956 25%

1957 28%

* 2 (2)=96.373; p<0.001 **2 (6)=52.981; p<0.001


Faculty of Nursing

Tafla 2.

Ástæður þess að konur segjast nota eða hafa notað tíðahvarfahormón (N=252)

Ástæða notkunar

Hlutfall kvenna sem

greina frá ástæðu

Hitakóf 51%

Svitakóf 50%

Svefntruflanir 40%

Til að sporna gegn beinþynningu 31%

Skapsveiflur 31%

Þunglyndi 11%

Brottnám annars eða beggja eggjastokka

10%

Kláði og óþægindi í slímhúð þvag- og kynfæra

10%

Til að fyrirbyggja hjartasjúkdóm 6%

Annað 19%


Faculty of Nursing

Tafla 3. Viðhorf kvenna til tíðahvarfa út frá notkun þeirra á tíðahvarfahormónum og hvort þær væru komnar á tíðahvörf.

Notar þú tíðahvarfahormón? Ert þú komin á tíðahvörf?

Notar núna

Hef notað en er hætt

Aldrei notað

Já

Nei

Veit ekki

Viðhorf til notkunar tíðahvarfahormóna

n 127 112 297 270 108 149

M + sf 2,6 + 0,4 2,1 + 0,6 2,0 + 0,6* 2,2 + 0,6 2,1 + 0,6 2,2 + 0,5

95% CI 2.51, 2.66 2.00, 2.23 1.94,2.07 2.13, 2.29 1.95, 2.18 2.07,2.24

Viðhorf til tíðahvarfa

n 117 100 263 250 97 128

M + sf 1,8 + 0,6 1,8 + 0,5 2,0 + 0,5** 1,9 + 0,5 2,0 + 0,5 1,9 + 0,5

95% CI 1.73,1.95 1.75,1.96 1.91,2.02 1.82, 1.96 1.89, 2.07 1.81, 1.97

*F(2,533)=51,354, p<0,001

**F(2,477)=3,051, p<0,05


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Symptom experience (N=561) Experienced symptoms %

No symptoms 20 Hot flashes 58

Sleep disturbance 51 Feeling exhausted 35 Mood swings 34 Woke up tired 33 Muscle & joint-aches 33 Oversensitivity 31 Restlessness 27 Decreased sex drive 27 Anxiety attacks 26 Changes in heart-beat 24 Difficulty concentrating 17 Vaginal irritation 17 Crying spells 13 Other sleep problems 7 Increased sex drive 6 Respiratory difficulties 5


Faculty of Nursing

Tafla 4. Hlutfall kvenna sem greina frá því að þær finni fyrir einkennum út frá hvort þær eru komnar á tíðahvörf og notkun tíðahvarfahormóna.

Ert þú komin á tíðahvörf? Notkun tíðahvarfahormóna

Einkenni

Já (n=277)

%

Nei (n=109)

%

Veit ekki (n=147)

%

2+

Notar (n=131)

%

Hætt notkun (n=115)

%

Aldrei notað (n=294)

%

2

Hita - og svitakóf 82 24 40 133,7* 79 79 41 73,3* Svefntruflanir 66 27 44 52,5* 66 69 38 45,2* Skapsveiflur 43 23 27 19,4 51 47 20 50,3* Vöðva - og liðverkir 42 17 28 24,3* 44 43 24 24,5* Mikil þreyta 40 19 35 15,5* 45 44 27 19,5* Vaknað óúthvíld 39 15 33 21,7* 42 40 27 16,3* Viðkvæmni 39 16 29 21,3* 48 39 21 35,7* Minnkuð kynhvöt 37 14 16 38,8** 41 35 18 28,8* Ónóg sjálfri sér 35 13 22 22,4* 43 34 17 35,4* Kvíðaköst 34 12 20 22,2* 37 34 16 27,3* Breytingar á hjartslætti 29 17 19 7,7** 22 34 20 9,4* Erfiðleikar með einbeitingu

24

7

11

20,4*

23

22

11

13,1*

Óþægindi í slímhúð þvagrásar og legganga

23

6

12

25,2*

20

25

12

11,8*

Grátköst af og til 17 6 12 8,01** 22 16 8 17,4* Aukin kynhvöt 7 6 5 0,3 7 5 7 0,3 Án einkenna 5 52 24 108,9* 5 1 35 84,8*

*<0.01 ** p<0.05


Faculty of Nursing

Tafla 5. Tilvist einkenna hjá konum út frá fæðingarári+

Greinir frá einkenni

Einkenni Já

M+sf Nei

M+sf

t.++ Hita - og svitakóf 3,6+2,0 4,6+2,0 6,066* Svefntruflanir 3,7+2,0 4,3+2,1 3,513* Skapsveiflur 4,0+2,1 3,9+2,1 0,586 Vöðva - og liðverkir 3,8+2,0 4,1+2,1 1,803 Mikil þreyta 4,1+2,0 3,9+2,1 -0,996 Vaknað óúthvíld 4,1+2,0 4,0+2,1 -0,517 Viðkvæmni 3,9+2,0 4,0+2,1 0,739 Minnkuð kynhvöt 3,8+2,0 4,1+2,1 1,204 Ónóg sjálfri sér 3,8+1,9 4,1+2,1 1,578 Kvíðaköst 3,7+1,9 4,1+2,1 1,864 Breytingar á hjartslætti 4,1+2,0 4,0+2,1 -0,747 Erfitt með einbeitingu 3,8+1,9 4,0+2,1 0,739 Óþægindi í slímhúð þvagrásar og legganga

3,6+2,0

4,1+2,1

2,007**

Grátköst af og til 3,9+2,0 4,0+2,1 0,458 Aukin kynhvöt 4,3+2,0 4,0+2,1 -0,802 Án einkenna 4,9+1,9 3,8+2,0 -5,078*

+fæðingarár 1951=1...1957=7, því bendir lægra meðaltal til hærri aldurs ++ DF=543 *<0.01 ** p<0.05


Faculty of Nursing

Information about menopause (N=561)

Yes

Have you received enough information about menopause? 51%

Do you think that the health authorities should provide more information about menopause? 84%

Have you heard about the (WHI study)? 65%


Faculty of Nursing

Tafla 6. Fræðsla um tíðahvörf kvenna og þekking á WHI rannsókninni(N=561)

Hvar hefur þú fengið fræðslu um tíðahvörf kvenna

%

Hvar heyrðir þú af WHI rannsókninni

%

Í fjölmiðlum 48 61

Hjá vinkonum 44 11 Hjá lækni 36 10 Annarsstaðar 23 2 Hjá vinnufélögum 18 11 Á veraldarvefnum 17 4 Hjá móður minni 13 0 Hjá hjúkrunarfræðingi 7 3 Hjá öðrum vinum 5 1 Hjá maka mínum 3 2 Hjá börnunum mínum 1 0


Faculty of Nursing

Source of information about menopause (N=561)Source of information about menopause (N=561)

Where did you receive education about menopause

0

10

20

30

40

50

60

Educational medium

%

Mass media

Female friends

Physician

Elsewhere

Colleagues

The internet

Mother

Nurse

Other friends

Spouse

Children


Faculty of Nursing

Source of information the WHI study (N=561)Source of information the WHI study (N=561)

Where did you hear about the WHI study?

0

10

20

30

40

50

60

70

Source of information

%

Mass media

Female friends

Colleagues

Physician

The internet

Nurse

Elsewhere

Spouse

Other friends

Mother

Children


Faculty of Nursing

Receiving information about menopause from a physician was associated with more postitive ATHT (t(514)=3.828;p<0.001)

Receiving the information from spouse (t(514=1.971; p<0.05) and other friends than female friends (t(514=2.540; p<0.05) is associated with more negative ATHT


Faculty of Nursing

Receiving information about the WHI-study from a physician was associated with more postitive ATHT (t(346)=2.815;p<0.001)


Faculty of Nursing

Use of hormonesUse of hormones

01020304050607080

Ever used(N=561)

Present use(N=252)

Cons. tostop use(N=113)

Consider touse (N=296)

YesNo


Faculty of Nursing

Tafla 7. Ástæður þess að konur hafa hætt, eða hugleitt að hætta notkun tíðahvarfahormóna Ástæður

Hlutfall kvenna sem hefur hugleitt að hætta

notkun (n=72)

Hlutfall kvenna sem hefur hætt notkun

(n=119) Ekki nóg vitað um áhættu af notkun

58

36

Niðurstöður WHI rannsóknar 53 38

Hræðsla við aukaverkanir 47 35

Hafði notað of lengi 17 10

Annað 14 28

Gögnuðust ekki 7 29


Faculty of Nursing

ATHT were more favourable among hormone users and previous users than amongst non-users (F(4.539)=27,927; p<0.001).


Faculty of Nursing

Tafla 8. Aðilar sem þátttakendur ræða við um hugleiðingar sínar og ákvörðun um að hætta eða hefja notkun tíðahvarfahormóna Aðilar sem rætt var við

Hlutfall kvenna sem hefur hugleitt að hætta notkun hormóna (n=72)

Hlutfall kvenna sem eru hættar

notkun hormóna (n=119)

Hlutfall kvenna sem hugleiða að

hefja notkun hormóna (n=60)

Lækni 64 48 43 Maki 44 22 13 Vinkonu(r) 42 13 33 Enginn 14 40 37 Vinnufélaga 8 1 10 Börn 4 3 - Móður 4 3 2 Hjúkrunarfræðing 4 3 3 Aðra 4 1 - Aðra vini 1 3 2


Faculty of Nursing

With whom have you discussed the With whom have you discussed the outcome of the WHI-study (N=561)?outcome of the WHI-study (N=561)?

Other friends 6% Mother 3% Nurse 3% Children 2%

0

5

10

15

20

25

30

35

40

1

Discussed with

%

Female Friends

Physician

Colleagues

Spouse

No-one

Other Friends

Mother

Nurse

Children


Faculty of Nursing

Having discussed the outcome of the WHI-study with a physician was associated with more postitive ATHT (t(346)=4.174;p<0.001)


Faculty of Nursing

Tafla 9. Notkun meðferða annarra en tíðahvarfahormón vegna einkenna sem tengjast tíðahvörfum

Meðferð Hlutfall kvenna sem hafði

notað meðferð (N=561) %

Ekkert af tilgreindri meðferð

42

Vítamín / Steinefni 36

Slökun 16

Náttúruleg hormón 14

Jurtate 11

Náttúrulyf 11

Hugleiðslu 5

Hómopatia 2

Nálastungur 2

Hnykkingar 1


Faculty of Nursing

Use of other methods to relieve symptoms Use of other methods to relieve symptoms (N=561)(N=561)

0

5

10

15

20

25

30

35

40

45

50

Remedy

%

Vitamins/minerals

Relaxation

Natural hormones

Chiropractics

Herbal te

Meditation

Acupuncture

Homeopathy

None of the above


Faculty of Nursing

Users of relaxation (t(494)=-2.346;p<0.05), natural medicine (t(439)=-2.466;p<0.05), and meditation (t(439)=-1.973;p<0.05), showed more negative ATHT than non-users

A user-index of alternative medicines was computed, representing the total number of different alternative remedies used. This scale had a correlation of rho= -0.10 (p=0.022), indicating that use of alternative remedies is negatively related to ATHT therapy.


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AttitudesAttitudes

The Pearson correlation between attitudes to menopause and attitudes to HT was r= -.034 (n.s.).


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Socio demographicsSocio demographics

76% married/cohabitation 76% participating in the workforce 32% finished university education with 33% having high

school diploma as a final degree Mean age was 49.8 (+ 2.2) years

The correlation of attitudes to HT with age was r=-0.12; (p=0.006)


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Final regression model explaining attitudes towards hormone therapy

R square total B Beta t sig.

Constant 1,989 19,023 0,001 Birth year 0,047 -0,02 -0,077 -1,373 0,171 Time since last period 0,06 0,007 0,066 1,178 0,24 Information from physician about menopause 0,093 0,171 0,138 2,642 0,009 Information from “other friends” about menopause 0,107 -0,171 -0,063 -1,215 0,225 Use of natural remedies’ 0,12 -0,201 -0,108 -2,086 0,038 Uses now, but has considered stopping use 0,174 0,506 0,306 5,601 0,001 Uses now and has not considered stopping use 0,252 0,55 0,291 5,467 0,001


Faculty of Nursing

Discussion and conclusionDiscussion and conclusion Physicians have great

influence on womens decision regarding use of HT

Physicians consultations regarding HT

Peri-menopausal women do not find menstrual education sufficient to meet their needs

Educate women


Faculty of NursingThank youThank you

faculty of nursing herdís sveinsdóttir1 women’s decision making and attitudes towards hormone...

Documents

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use of ht

whi study herds sveinsdttir

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university of iceland

study variables